Antidepressants are No Better than Sugar Pills? Well...
Antidepressants in the SSRI family don't appear to be any more effective than a placebo in treating any but the most severely depressed people. That's the conclusion of a study published last week in the Public Library of Science Medicine. The study analyzed trial results, both published and unpublished, of six widely prescribed SSRIs. The researchers found that a placebo worked just as well as the SSRIs for people with mild or moderate depression.
I don't find these conclusions particularly surprising. To my mind, there are very few situations in which someone with mild depression should be prescribed an antidepressant. Actually, I can't think of even one, but bear in mind that I'm not a doctor. However, I think that most doctors would agree that other approaches are as effective, such as talk therapy and exercise. Whether or not moderate depression should be treated with antidepressants is a little more complicated. My take on it is that antidepressants shouldn't necessarily be the first line of defense.
Unfortunately, they often are. There's no doubt in my mind that antidepressants are over-prescribed. Part of this is due to the lack of experience that many family doctors have in treating depression. And make no mistake, it is not always mental health professionals who are prescribing antidepressants. In some cases, it's because there are not enough qualified mental health professionals in an area and in some cases it's because the patient is more comfortable with their family doctor than with a strange doctor.
The other reason that antidepressants are so popular has to do with money. As I said in another SharePost, health insurance companies tend to make it difficult for depressed patients to pursue the most effective alternative, which is psychotherapy. It's simple math. One therapy session costs anywhere from $75-150 on average. Most patients see their therapist at least once a week. Antidepressant treatment, however, generally costs, at most, $200-300 per month.
However, though I believe that antidepressants are prescribed in many inappropriate situations, I have grave concerns about the study's impact, to a great extent because of the treatment that it was given in the press. Many articles that cited the study failed to note that it was only one class of antidepressants that had been studied, or noted this after the first paragraph.
And let's face it, many people won't get past the headline or first paragraph of these articles, which in most cases said, "Antidepressants no better than placebo" instead of "Some antidepressants no better than placebo" (remember that only one class of antidepressants was examined). Here, for instance, is the first paragraph from an article in The Guardian online: "Prozac, the bestselling antidepressant taken by 40 million people worldwide, does not work and nor do similar drugs in the same class, according to a major review released today." The fourth paragraph of the article finally gets around to mentioning that the exception was severely depressed people.
Another concern of mine is the completeness, or lack thereof, of the study. I've discussed before how studies can be skewed or slanted (deliberately or accidentally) in one direction or another. In this case, I don't think that the study was skewed, but it was limited in its scope. Literally, actually. The trial results that the study examined only covered six weeks of treatment with antidepressants The question is - how many people who were given placebos subsequently had a relapse of depression symptoms? Sometimes the mind does heal itself, but in many cases, once you have suffered a bout of depression, it can recur the rest of your life.
If you or someone you know has seen these reports and concluded that it's not worth taking antidepressants anymore, there's one thing I must urge you to consider. It is very important that you discontinue your medication with the help of your doctor. He or she can help you taper off and avoid any unpleasant withdrawal symptoms.
Published On: March 06, 2008